How to help someone who is showing signs of psychosis?March 10, 2010 2:44 PMSubscribe

My best friend appears to be sliding into psychosis. Who and how should I approach in order to help him out? I know IANAD and YANAD - but I need less info on diagnosis and more info/personal experiences/stories about reaching out to someone who has a undiagnosed mental illness in order to help them.

In order to help you guys get a real grasp of my friend's situation, I'm gonna give you some background history, and then a record of some of the very disturbing encounters I've had with him recently. Then I'll finally get around to elaborating on my question of how to handle this situation - who to talk to, what to say, how to approach, all that. I would really appreciate it if anyone who has personal stories or experiences with this sort of situation would share with me, as I'm totally at a loss as to how to proceed.

- Also, I know very similar questions have been asked in the past, but I'm looking for something other than the normal "get him to a doctor" response. I want more than anything to get him there - it's how that I'm confused about.

Background info: The person in question, let's call him S. I have been best friends with S since the third grade, so we have been extremely close and known each other extremely well for a long time. S. currently lives about an hour's drive from me, where he attends a different university. However, we see each other almost every week, and a whole lot more during breaks. We're both in our early 20s and male.

About a year and a half ago, S. got heavy into LSD. At first it was every weekend, and then he started using it during the school week, even going to class while tripping. This lasted for about a semester, before his source dried up and LSD had lost its novelty. I know he also has taken a lot of mushrooms, as well as some more exotic stuff like DMT, MDMA. During this same time period, his very serious relationship with his long-term girlfriend (one of his first partners) dissolved after she decided to go for his roommate instead. This messed him up a whole lot in the head, but it seemed after awhile as if he got over it. It's only now that I'm realizing maybe the shock and trauma didn't dissipate so easily.

I mention all this because it was about 6 months after this intense period of drug use that he started to change - a lot.

Symptoms/Signs of Illness

First example: One night it was I, S., my girlfriend and S's roommate, hanging out. We were just sitting around, sipping beers and listening to new music. I noticed that S. was very, very withdrawn and couldn't be coaxed to start any sort of conversation, and had to basically be forced to say anything about anything. This is when I started to worry, and this is when things got progressively more disturbing. We continued to chat about music for the rest of the night (we being my girlfriend, S's roommate and I) and shyed away from trying too hard to incorporate S into the discussion. However, after awhile, S began to become more and more agitated, and would burst into our conversations with remarks like "Why do you guys always have to talk about me in front of my face?" & "Why do you keep insulting and criticizing me, when I'm right here?" etc. I.e. He was interpreting everything we said, which was merely mundane music trivia, as attacks, affronts and comments about him. We told him each time "We're not talking about you at all, we're talking about [this musical act]" but he would just looked confused, suspicious and then finally would say "Oh....ok."

This type of thing has happened occasionally since, but not with the intensity of that first time (i.e. he'll interpret one or two comments or conversations this way, but won't keep insisting on it the whole night after we explain to him what we're actually talking about.)

I went to visit him last weekend, and upon arriving he seemed pretty OK. However, as the night wore on, and we sat around talking (he really didn't feel like leaving his house, even though no one else was home and there was nothing to do, and we were supposed to be meeting people downtown), things started to get weird again. Finally, he told me "I want to tell you something." He went on to explain that when he'd been walking around downtown recently, he had started to notice strange connections between everyone and everything around him. For instance, he would hear one person talking on their cellphone on his side of the street, and then would immediately notice how a person across the street, also on their cellphone, would start talking about what the first person had been speaking about.

He said everyone he met was subtly influencing each other, and that he was the only one who could notice this. Even stranger, he said that he could tell in such small and subtle things such as a change in someone's posture, or small movements of their hands, heads, or the direction they were walking in, that the person in question had heard all of the other people's conversations and was acting in response to these conversations.

Example: A person who heard another person, further down the street talking on their cellphone, would shift their feet as a sign that they were in on the conversation, and this shift itself was a message or a sign that could be interpreted. Sometimes these messages were directed to the voice on the phone, other times, to S. himself. S. said he had experienced this a lot recently, and that it was a new phenomenon.

Even more chilling than all of this (which was so disturbing I had goosebumps for half an hour afterwards) was S's face and demeanor as he told me all this. Completely cold, inexpressive, flat. This flat affect isn't restricted to when he is telling of his strange experiences, however - ever since he started to change, S. has had an increasingly flat affect speaking or doing anything. I've seen maybe one or two smiles in as many months. And while he's always been just a little quiet, in this time period he has stopped initiating conversations completely, and will only reply when absolutely necessary or when he has been continually goaded by those around him to answer.

His performance in school has also drastically gotten worse. In school together, we were two of the brightest kids in our school. And while earlier in college, he was bored with the material and smoking a moderately unhealthy amount of marijuana, he still managed to do very well, even in courses he had no interest in. However, recently, he has completely given up on attending class or doing any coursework, and as a result has failed quite a few courses and this has caused his graduation to be pushed back an entire semester.

To summarize:
1) S definitely shows signs of having ideas of reference - both when he has conversations with friends (when he thinks they are covertly attacking him) and when he is out in world (when he sees all human activity around him as holding some secret, significant meaning, and all of these activities seem to be interconnected and influencing each other)
2) He also definitely has a blunted/flat affect & poverty of speech
3) I believe it is very possible that the voices he claims to hear when walking down the street (especially when the owner of that voice is supposed to be a voice on a cellphone across or a block or two down the street from him) are audio hallucinations, but it's hard to be sure. Problem is, if he has been hearing voices, I believe that he would probably try to hide that from me.
4) He has become increasingly socially withdrawn and isolated, and his school and work lives have suffered as a result, not to mention his friendships.

All of this leads me to conclude (although IANAD) that there is a good chance he is developing symptoms of schizophrenia. Considering the amount of LSD he used prior to this period, and the emotional turmoil he was going through at the time, I think this might have contributed to bringing what was previously a latent condition to the surface.

So finally, to elaborate on my question: How should I handle this situation? I love S. dearly, he has always been my best friend, and he's an amazing person and an amazing musician. Watching him slowly fall into a very deep hole is killing me, and on an even more basic level, I really miss having a connection with him. He's just not there anymore really, most of the time.

My problem is that I think confronting him, or even politely and suavely suggesting that he see someone, would bring about a very violent rejection. Considering how he is already paranoid in conversations about completely innocent topics, I can't imagine my telling him that I'm afraid he has a mental illness would turn out too well. I just don't know who else to go to - his parents? I'm just afraid to make the wrong move because I really want him to get help and I don't want to make him shut me out.

He is capable of acting semi-normally for periods of time (although if you knew him before this period you could immediately tell something is off) so I'm afraid of broaching the subject, because although I've seen enough to totally convince me that he's at serious risk, I think it's possible that he could mask his symptoms and hide what's going on for a couple more months at least. Which would be pretty bad regardless, but I also know that he has continued to use mushrooms and excessive amounts of marijuana, and I'm afraid those things, if he continues to use them regularly, will only make his condition deteriorate more.

So what should I do? Try to talk to him about it, despite the high chance that he'll disregard all I'm saying and possibly cut the ties between us? Try to talk to his parents, despite the fact that he probably acts relatively normal around them (or so I imagine), and then risk the chance of him denying everything to them and then, once again, cutting me off? Or try to meet with him with several more of our friends, because I'm only one of many who have noticed the changes he has undergone recently? None of the above? Something else? Nothing at all?

I care about this guy a lot so I want to help him the best way I can, I've just never had an experience like this, and don't know how to handle it. I have lots of experience with mental illness (personal experience and otherwise) but this is the first time (and hopefully the only time) I've had to basically watch a friend slowly drown in his illness without knowing what to do to save him.

Him possibly getting pissed at you is NOT a good reason not to help him.This kind of behavior is super-disturbing. If you're a good friend, you'll look out for him when he doesn't seem quite able to be looking out for himself.

Think about it this way: you're worried about him cutting you off. He's already cut off by his own illness. If something happened to him that caused him to no longer be around you anymore, you want that to be because people who cared about him were trying to help him, and he's off getting help, not because he's dead or on the street or who knows what.posted by mneekadon at 3:11 PM on March 10, 2010 [3 favorites]

I just don't know who else to go to - his parents?

Yes. Tell them what you've witnessed, get other friends to corroborate if need be. You don't know that he acts normal around them. You don't know that he'll cut you off. You're pretty much going to lose his friendship either way, as he's not the same person you used to know. If he was bleeding, you'd get him to a hospital. So encourage his parents to consult a doctor. I would leave an "intervention" to trained professionals. You'll just become part of his conspiracy.

If his parents (or you) need a place to turn to, refer them to NAMI.posted by desjardins at 3:27 PM on March 10, 2010

Very good points. And maybe something I should clarify a bit: I'm afraid of him getting upset/cutting me off, etc., not because I want him to be happy with me, but because I am one of the closest people to him right now, and one of a handful who is aware what's going on with him right now. His parents haven't a clue, his roommate is apathetic, and the majority of the rest of our friends live where I do and don't make it out to see him very often.

So I'm afraid that if in the process of initially trying to get him help, he cuts me off, that he would become even more isolated, and would have much less support and people looking out for him. In which case, he might get worse or merely persist in the state he's in for a long time before either doing something extreme which results in a diagnosis (ending up in the ER or in the custody of the police) or acting bizarre enough consistently in everyday life that someone else takes a interest and tries to help him. I am just very worried that his condition is getting progressively worse, and that his lifestyle isn't helping matters at all.

I definitely want to and am willing to do whatever it takes to help him, but I just want to make sure I take the right steps so that I don't screw up the whole process, and delay him getting help any longer than absolutely necessary. How would you like to be told, if he was your son? "Dear Mrs. So-and-So, S. has been acting very strange recently. These are somethings I've noticed..." ?posted by operaposthuma at 3:27 PM on March 10, 2010

I know you are hoping for personal experiences and not just the "get him to a doctor" stuff, but this kind of thing is far too vast and heavy for you to handle on your own. Ultimately, he needs professional help. But if he's sliding into paranoia the way it seems, it seems to me that any attempt to "confront" him about it, even gently, will cause him to think you're a "part of" what's going on. It says good things that he's still willing to confide in you, and I think that even the fact that you listen to him when he wants to talk can be good. I would try to continue to do that, just so he's not further isolated.

However, if you do really want to help, I think someone needs to be alerted. I agree with mneekadon that if it were my son or daughter, I'd want to know. Hell, if I ever become incapable of distinguishing between reality and my own sickness, I'd want a friend to tell my parents, just so that someone can get help. He may feel like you've betrayed him by "telling" on him, but he's not thinking rationally at this point.

It sounds like you're both still in school. Have you considered looking into any helplines or therapy your school offers, if you're not comfortable telling his parents? Colleges are often eager to make sure their students are of sound mind (...unfortunately, often because they want to cover themselves from lawsuits, but who cares, if they're providing help) and will provide free resources. At the very least, if you can't refer him/he won't call himself, you can see if there's anyone more equipped to help out who can guide you in the right direction.

Good luck to you and S. I hope that I have friends who care as much as you do if anything ever happens to me.posted by alleycat01 at 3:33 PM on March 10, 2010 [2 favorites]

"Hi Mrs. S, I'm very concerned about your son. In the past few months he's been behaving strangely and does not seem like his normal self. For instance, he [examples of behavior]. I really think he needs to see a doctor, but I'm afraid he might get defensive or paranoid if this is suggested to him. I'm not a professional and I don't know the best way to proceed. Do you have a family doctor you can talk to about this before you talk to S?"posted by desjardins at 3:34 PM on March 10, 2010 [6 favorites]

This looks like a good site with many resources. See the sections called "What to do if you suspect you or a loved one may have a psychiatric disorder" and "What if my family member refuses to see a doctor?"

Your friend does need to see a doctor, and he needs to see one sooner rather than later, as this won't go away. It will likely worsen and become more difficult to treat. Someone will have to attempt to bring the topic up with him, whether that's you or his family. Maybe you can brainstorm with his family how best to do this. This is very tough. Good luck. I hope someone who has experienced these symptoms and gotten help will read this and be able to offer some advice.posted by kitcat at 3:37 PM on March 10, 2010 [1 favorite]

I'm sorry to say that (as you probably know) it's very hard to get psychiatric help for an adult who doesn't want it.

You should definitely tell his parents, who may have a better chance of getting help for him than you do. Make it clear to them that you're speaking as his friend, as someone who knows him quite well. When I was a parent in a similar situation, I was not properly responsive when I was told - I imagined that it was simply a difference of opinion and not a mental illness - so you should be well prepared with detailed descriptions.

There's probably little you can do yourself for your friend, except being someone to talk to when/if he wants that.

My brother-in-law had his first psychotic episode in his early 20s. It came on relatively slowly at first, so his friends had to deal with similar stuff like you are right now -- acting relatively sane but saying crazy things, like everything is connected, he can read people's minds, the CIA is reading his mind, etc. Distressing for his friends to be sure.

You need to tell his parents. I understand your fear that he'll cut you out or whatever, but you're not in a great position to get him the help he needs. His parents are in a better position. You could copy and paste stuff that you've said here, even. There's no easy way to tell a parent their child is going crazy, or that you think drug use might have brought it on, etc, but if you care about the guy you will do it anyway. You can ask his parents not to bring up that you said anything. When we figured out my brother-in-law was crazy, no one actually went to him at first and was like, "Hey, you're crazy, so-and-so told me." Instead, his dad just took him for a few days to observe him like nothing weird was going on, and once he was convinced, then he looked into treatment and talked to my brother-in-law about it. There's no reason to assume your friend will be made aware of your involvement.posted by Nattie at 3:44 PM on March 10, 2010 [4 favorites]

IANAD, but I have a bit of experience in this situation. In the past 20+ years I've been close to two individuals who slowly started acting erratically ~ > strangely and who were eventually diagnozed with schizophrenia. The one case sounds similar to yours - my friend's brother picked us up from college one day to drive us home (I lived very nearby) for Spring break. It was a hot day, but he refused to turn on the A/C or roll down the windows. His reason: the CIA was monitoring the car, and we couldn't let signals out through the vents or the windows. When we got to my friend's house, she asked her parents "What's wrong with John?" They had no idea what she meant. Upon explanation they said something like "Oh, sometimes he talks about fantastic things, but that's just John and his imagination...." Either they were in denial, or his paranoid periods were far enough between that they just chalked it up to momentary flashes of daydreaming. When the parents were finally convinced that John needed professional mental help, they made an appointment with a doctor and then lied to John to get him to the office (he was a heavy smoker and a college student, and thus was still on their Blue Cross insurance. They made up some story about their rates going up unless he underwent a physical.)

So, to summarize, I would definitely address your concerns to your friend's parents, but also be forearmed with information (you can start with the county health department) as to where your friend can be taken for evaluation and assistance. Also warn them that Friend might not be amenable to seeing a psych doctor, so they might have to come up with some sort of convincing stretch-of-the-truth to get him there. Best of luck to you.posted by Oriole Adams at 3:44 PM on March 10, 2010 [1 favorite]

Yes, contact his parents. I would be surprised if they're not already at least somewhat aware of this, but may be experiencing some denial or uncertainty, and a trusted third party might be the jolt they need to get their son help.

BTW, it seems like you've done your schizophrenia research, so you probably also know that late teens-early twenties is sort of the "danger time" for young men developing symptoms of the disease. Several guys I grew up with went through this at around this time (including my best friend from my neighborhood), as did my dad's best friend from childhood.

The good news is that schizophrenia doesn't have to be a lifetime sentence to the mental ward. Two of the aforementioned guys I grew up with are now living stable lives. They were also two of the best students in our school, and they probably have not achieved as much as their parents once hoped, but they are healthy and stable. I think the key was that they got the help they needed at the onset of these symptoms. You have to at least try. You can't control how he reacts, but you can at least try.

I've been there. It's awful. I'm so sorry, for you and your friend too.

-I'd tell his parents, for reasons that others have stated.
-If you have to talk to him, tell several people when and where it will happen, make sure you have your cell phone, and don't go far from populated areas. People with schizophrenia are actually rarely violent, but anything could happen - from a violent reaction to your friend running away in fear. (And of course, we're not doctors here, perhaps your friend does NOT have schizophrenia, though he sounds more or less exactly like my friend who does.) You want to be able to respond effectively to whatever happens. Such precautions will help you focus on talking to your friend.
-Don't approach him with anything like "I think you're experiencing psychosis". Tell him you've noticed that he seems nervous and unhappy, and not himself. Tell him you're very worried about him and want to help in any way. In a best-case scenario, your friend, who may have an inkling of what's going on, may be able to confide in you that he's scared, or not sure what's going on with him and his reality. In that case, don't try to persuade him that he is indeed psychotic, just try to speak to his feelings. You may not be able to convince him to go to a doctor, but you may be able to gently suggest that you hope he can find help somewhere, because you don't know how to help. That might be enough for one conversation.
-If the situation gets too intense for you to handle, you can call the police. They will come get your friend and take him to the hospital. Your friend may or may not be able to feign normalcy long enough to pass the interview at the hospital. He may or may not be terrifically angry with you. My friend was, and it took a long time for him to get over it. But at least he's stable now, doing really well, completing his graduate degree, and lives a more or less normal life. I know how horrible it can be to feel like you're betraying the trust of your friend by calling in the Authorities, but sometimes, the burden of severe mental illness is just more than a person can stand and professionals are needed. You should NOT feel guilty about calling for help if it comes to that.
-Remember that there's a huge stigma attached to mental illnesses like schizophrenia. Through the mess, and especially once your friend is being treated for his condition (I'm being optimistic here and assuming he WILL be treated), be as clear as you can that you're not thinking less of him because of this, and that you won't abandon him. I KNOW such situations can be really really scary - I was terrified, unsure of myself, afraid to do the wrong thing - but try not to let that show. In almost every other case, I'd advocate emotional honesty, but in this case, I think one of the best things you can do for your friend is never to show it if you're afraid of him. Severe mental illnesses can make people feel like monsters in the eyes of others - but you can make him feel like the loved human being he is.posted by Cygnet at 3:53 PM on March 10, 2010

I am sure this must be a tremendous internal struggle for you. You are probably feeling grief over the change in this person just as much as you are feeling confusion over what to do. I've been there myself.

Lots of the advice on here has been good and I want to add that you need to make sure you remember that although you are connected to your friend, do not let this situation become your problem. I don't mean that in the way a bad customer service rep would say, "that's not my problem!" I mean it in a way that you need to define your boundary immediately when it comes to getting yourself involved and constantly check with yourself to make sure you aren't turning your own life upside down while trying to help this friend. It's doubtful that your friend would want you to do that to yourself.

Do what you can, be there for your friend, show love. But maintain the balance in your own life as much as you can even if it means making some tough decisions.posted by thorny at 4:20 PM on March 10, 2010 [3 favorites]

Also consider that he might be using other drugs you're unaware of. Based on what you said about his LSD use, he probably does not take drugs in moderation. I mean, if he started out using LSD every weekend... well, weekly LSD is a lot of LSD. Drug-induced psychosis is a real thing. Also, a person could have problems with drug use and mental health at the same time.posted by selfmedicating at 4:51 PM on March 10, 2010

Firstly: this must be terribly hard for you, and I'm sorry you have to go through it.

Second: as everyone has said, tell his folks if you can. I don't know what his adult status is in the context of mental health treatment, but I would imagine he is, and there might well be difficulties getting him to treatment if he doesn't want to go, and hasn't done anything to get himself there for public safety reasons.

Third: he really does need medical intervention. IANAD but it sounds like a delusional psychotic episode of some sort, and you can't deal with those as an amateur. Neither can he. There are some good prognoses, and you owe it him to give him the best chance of them.

Four: parents first, but if they don't respond well you might want to consider evaluating the student welfare service at your friends college. A good school would want to know if a student was in the early stages of serious mental illness. I would imagine you could arrange to talk to someone without mentioning your friends name at all to find out what the university's approach would be, and if you think it sounds sensible consider telling them his identity.

Informing his college sounds drastic, but so is the problem and he needs every chance of help.posted by cromagnon at 5:26 PM on March 10, 2010 [1 favorite]

I'm sorry for your friend (and you), but am glad he has you looking out for him. A number of people have advocated approaching S's parents, which seems like a good idea to me as well. I am not a mental health professional or anything like that, but I do have personal experience with trying to convince someone that their family member is mentally ill and needs to see a doctor. It isn't always easy. You don't give us much background about S's parents, other than telling us they're currently oblivious to their son's condition. If they don't have much knowledge of psychological disorders, they may not have the information necessary to recognize S's symptoms and know what they should do to help. Anyhow, here are a few things to think about before approaching his parents:

-You may need to educate them about psychosis and schizophrenia as well as informing them about their son's recent behavior. It may be useful to have information on hand you can give them (or email them if you're talking on the phone). This should be from a reputable, recognizable source. Here, for example, is the Mayo Clinic's description of the symptoms of schizophrenia. As well as a description of the symptoms, you may want to be prepared with information on treatment and prognosis, as well as professional recommendations about what to do when someone you know displays worrying symptoms. Your friend's parents may regard you as a kid without much authority, so having credible, impartial documents might help them take you more seriously.

-Keep your eye on the ball. Your goal here is to get S to a doctor's office. S's parents don't need to agree about your suspected diagnosis or any other specific item, they just need to be concerned enough to take steps toward getting him evaluated by a clinician.

-This may be a multi-step process. Consider your effort a success even if you just make his parents aware that there might be a problem, what symptoms they should look for, and what they should do if they come to believe he needs help. As you've learned already, it can be very disturbing to realize that a loved one has a serious mental health problem, and each person has to come to terms with it at his or her own pace. Let them know that you'll be happy to talk to them again after they've done more research and thought about the situation. Be calm and respectful, but don't back down from the things you know to be true and have heard from S's own lips.posted by unsub at 5:42 PM on March 10, 2010

I can't add much to the good advice already given above, but in my experience emergency mental health care (both voluntary and involuntary) is much easier to obtain for people who are actively psychotic (auditory hallucinations and command hallucinations are both symptoms of active psychosis) than for almost anyone else.

The actively delusional psychotic generally doesn't go out of their way to mask their delusions - the alternate reality in which people exist in active psychosis is so real to them that they're usually well past the point of concealing it and will often share their thoughts in considerable detail. It's hard to convince them they need help precisely because they no longer relate to objective reality, but it's also hard for them to hide the fact that they are totally disconnected from objective reality.

The treatment for psychosis depends on its cause, but the very best chance your friend has of being able to lead a functional life is to get diagnosed while he's frankly symptomatic. Whatever resources you decide to call in - and this is way beyond the capacity of non-professionals to deal with - please do call in some professional resources, even if its just a student welfare person at his university. With or without his family's involvement (and sometimes families deny there's a problem for decades), he's worthy of whatever professional help you are able to arrange for him. Let arranging it as soon as possible be your gift to both of you.posted by Lolie at 5:43 PM on March 10, 2010 [1 favorite]

My ex-husband developed paranoid schizophrenia 10 years after we divorced. He had no family that cared about him, so it was left to his landlady and me to help him. He would show up on my doorstep at 4 a.m. and talk to the voices. He came to my job and tried to drag me out by the neck. Etc., etc.

I would agree with telling his parents, but I'll offer some other advice. Keep in mind that if your suspicions are correct and it is schizophrenia (and it definitely sounds like it), then the voices may be (probably are) telling him that you are out to get him. So first and foremost, protect your own safety.

When my ex would show up at my house in the middle of an "episode", I would try to talk to him reasonably but also a bit as if I was talking to a child. What seemed to get through to him was when I would ask him "Are you okay? Do you need me to get you some help?" It also helped when I reminded him gently that we had known each other for decades, that I had never tried to hurt him, that we had a daughter together and I therefore had a reason to want to help him rather than hurt him, etc. I pointed out that the people (hallucinated voices) who were telling him to do bad things weren't his friends, he didn't know them, etc., but that he knew deep in his heart that he could trust me, and did he want me to find him some help?

Wording things correctly can be a bit tricky. I didn't just say "Do you want me to take you to a doctor?", I said "Do you want me to find you some help?" Because doctors are part of the "they" who are out to get him. I always put everything I said in the context of helping him. One night when I was particularly afraid that he was going to get violent, I knew I needed to call the police. So I told him "I'm going to see if I can get the police to come and give you a ride to a doctor who can help you." I did mention "doctor" in that instance, because I felt it was important not to outright lie to him at that point, because I was the only person he trusted, and I wanted him to continue to trust me so that he would let me help him.

This brings up another point - be careful about involving the police. Call them if you need to, but the two times I called them, it took them 2 - 4 1/2 hours to show up, even though I lived a 5 minute walk from the police station. Of course, he was long gone by then. Police don't seem to really like to deal with these things, not that I can blame them, but unless it sounds like an immediate emergency (mine wasn't, because he wasn't in my house, merely on the doorstep), then they may try to put it off. If they do think it's an emergency, they're liable to show up with sirens screaming and guns drawn. I don't mean to scare you, but it's important that you are aware of the potential for things to get out of hand.

Also be aware that there is only so much you can do. As a previous comment said, don't make it your problem. Yes, you care - but there is only so much you can do, and these things can very quickly take over your whole life. One of the most difficult aspects of dealing with schizophrenics is that they are suspicious of everyone and everything. This means that even if you are successful in getting them to a doctor and they are prescribed medication, they won't necessarily take it. Because in their mind, the doctor is part of the conspiracy, and wants them to take the meds so that they will spill their secrets, or something similar. So this can be a never-ending problem to deal with.posted by MexicanYenta at 5:54 PM on March 10, 2010 [1 favorite]

As a person with lots of schizophrenia in the family, I'd say tell the parents as well. If they haven't noticed something about their son, they're probably just as confused and worried as you are, and if they haven't, they would definitely want to know.

As for how to deal with him, you don't have to buy into his delusions or humor him or anything... I remember reading somewhere, that if someone said, "The toaster was talking to me today," the correct response is to ask, "What did it say?" Ask questions, so if his parent or doctor asks you what he is saying/doing/etc, you can use whatever information he may give you to help him.posted by mornie_alantie at 7:16 PM on March 10, 2010

Considering the amount of LSD he used prior to this period, and the emotional turmoil he was going through at the time, I think this might have contributed to bringing what was previously a latent condition to the surface.

Just as a side note, latent schizophrenia often presents itself in the mid to late twenties regardless of drug use or anything else.

As for your situation all I can tell you is what we did for a friend of ours who developed similar symptoms -- let her family know. One thing we did *not* do (based on professional advice) was argue with or contradict her. She needed friends, and someone going down the hole into paranoia will very quickly decide that anyone who tries to argue with what they're experiencing is part of the conspiracy.

Eventually her parents had her committed to a mental institution for a few months after which she lived with them for another year. She appears to have made a full recovery.posted by Tell Me No Lies at 7:43 PM on March 10, 2010

Just to play devil's advocate here:

Though the amount of people backing you up on the inexpert diagnosis of mental illness may seem conclusive, all anyone has to go on is your subjective accounting of his behaviours. While much of what you said seems objectively strange, has it occurred to you that you are overreacting, and there are reasons why one might claim to notice patterns others don't, and to withdraw socially that don't involve schizophrenia, per se?

If he is really your best friend, why not talk to him about how strange his behaviours seem? Your fear of a violent response seems somewhat unfounded, as nothing you have said indicates he is a violent person. He may very well be suffering from some kind of mental illness, but if you care about him, I think you owe it to him to give him your honest evaluation before going to anyone else.

I say this because, maybe, in your own extremely conditioned state you are only perceiving what you believe to be the rational disconnects in what he is telling you, when maybe the truth is that you simply aren't listening to the right details, or he isn't able to convey them in the right way to make you understand. In other words, he could be right.

Either way, getting him evaluated by an actual professional would be a good first step. But he is going to have enough people trying to fit him into a particular mold of psychological illness without his own good friend doing it as well. Trying to figure out whether he needs help, and helping in the process of finding that out is one thing, but I think a good friend is always seeking ways to understand their friends, no matter how strange they may seem, and you seem to be way too focussed on how unusual (measured by YOUR standards) his behaviour is.

One of my own good friends has acted, in recent years, much the same as you describe your friend. So maybe I'm just justifying my own inaction in this regard, but... You have to realize, that when a person hasn't demonstrated any violent or self-destructive (besides drugs, but c'mon, really?) tendencies, what are you really saving them from? The reality is that if you talk to his parents and lay out your alarmist viewpoint, you may find that years from now, because of this strangeness stigmatization you seem so intent to lay upon him, he has gone from being a "really strange" guy, to a barely conscious doped up semi-institutionalized shell of what he used to be, because of events that you brought into motion. If you can live with that, then so be it. But again I ask, what are you saving him from?

Again, the people above me probably know what they are talking about far more than I do, but I thought I'd offer a different perspective anyways.posted by paradoxflow at 11:04 PM on March 10, 2010

what are you saving him from?

I understand you're just playing devil's advocate, but this is potentially dangerous advice. When my brother-in-law starting noticing these "patterns" everywhere, it was only a month until he crashed his car into the side of a building because he needed to "prove" something to the CIA. Shortly before that he also started driving extremely fast and recklessly, and he justified this on the grounds that he could tell what other people were thinking. Once he had a psychiatrist, he confessed that he had thought about killing his father recently, which explained why he had suddenly become obsessed with some swords my husband collected when he was a kid. When my husband had to babysit him so his father could have a break, he wandered away from my husband's workplace and got lost along a freeway.

So he could be saving his friend from death or saving someone else from being harmed by his friend. His friend isn't "right" about anything crazy he's said. There's no failure of communication that can account for any of it. People on one side of a street do not have knowledge of people's cell phone conversations on the other side of the street, and they do not communicate in a silent language about these things. I think it's a bit out of line to suggest that the OP's friend will end up doped up in an institution, and that if it happens, it will be something that he's responsible for. Plenty of people who experience psychosis take medication and lead normal lives, especially if they have a family that's there for them when they first have the episode. Of the four people I know that have had psychotic episodes and take medication for them, none of them are doped up in an institution or ever have been. You'd never even know they had any issues with it in the past. If the people around them had just let them to their own devices they would be deprived of the lives they live now, and the paranoid ones among those would be living in constant terror -- which is yet another thing he would be saving his friend from.posted by Nattie at 11:44 PM on March 10, 2010 [5 favorites]

I want to praise the OP and many of the others in this thread for the efforts you have made and intend to make to help your friends. My oldest friend began having delusions of persecution a couple of years ago--with all the details--and I have been unable to help him.

In fact, I felt I had to cut him off when he decided to move to my city and be homeless in my neighborhood, and repeatedly showed no signs of progress toward getting help or getting better. I know he came to be close to me, but he began to suspect me of more and more involvement with 'them.' I was afraid for my home and loved ones, and had to tell him to stop coming around.

Just as a point - people with untreated mental illness may take marijuana, LSD, etc. to try and self medicate. They may not be as unconnected as previous posters have indicated and yet it may not be causative either.posted by Sophie1 at 8:16 AM on March 11, 2010 [1 favorite]

Desjardins has written what I think is a perfect note to send to his parents - not least because it contains only your objective, first-hand observations, and no speculation on your part about what his problem is or might be. Though you are obviously very bright, and have clearly done a lot of research, you are a contemporary of their son, and S's parents may not be entirely receptive to any attempt at diagnosis on your part. However, whether they are receptive or not, they absolutely need to be informed of what you have observed first hand.

Also, consistent with thorny's advice, you need to recognize your limitations, not only to maintain your own emotional equilibrium, but as a practical matter. You have basically no ability to manage or control S's life, and, if he is an adult, even his parents may not have legal ability to insist he see a doctor or get treatment.

I would advise you - if I may be so bold - to observe the tenets of the Serenity Prayer: "Give me the courage to change the things I can change; the serenity to accept the things I cannot change, and the wisdom to know the difference". In this situation, what you are able to do is: 1) let his parents know what you have observed, and 2) be a consistent and loving presence in S's life, and also in that of his parents, who may take great comfort in knowing their son has such a devoted and caring friend.

Because the type of problems your friend is experiencing are likely organic, electro-chemical brain disturbances, it is unlikely you will be able to help him much (at least at this point) by simply listening to and supporting him. As desjardine also said, if S were bleeding you would get him to a hospital, because you would be incapable of fixing the problem yourself. You cannot fix him now, and I believe you serve him best by having the courage to advise those who may be able to help himposted by cookiesncream at 8:27 AM on March 11, 2010 [1 favorite]

Something else I thought of last nite (I woke up several times thinking about you and S, and the difficult, painful situation you both are in): I am not quite the age of what I imagine S's parents to be (50's?), but, if I project myself into their place, I would be BEYOND furious if I found out my child had been ill for some time, that his closest friend had known about it, and had withheld the knowledge from me. If you've been S's friend since third grade, you must have some acquaintaince with his parents. You don't mention whether you see them as loving, involved parents, or distant and preoccupied with other things, but, in any event, their reaction is another thing you cannot control.

You have, at this point, only one way to help your friend, and that is to tell his parents, and/or any other close relatives, and/or any other individuals who may be in a position to help, such as medical/administrative/guidance/emotional support-type personnel in your university, a local mental health clinic, or whoever. Those who cannot help directly may be able to provide information or resources you didn't know about previously. Perhaps they can connect with his parents to formulate the best possible plan to help S. I know you are concerned that S may find out about your "betrayal", and stop seeing you as a friend and confidante; unfortunately, it is entirely possible he will do this anyway, because his illness can rob him of the ability to formulate logical thoughts and responses. Sadly, it is possible that he may see you cross your legs, take a picture with your cell phone, squint, sneeze, scratch, or whatever, and decide you have been on the side of the "enemy" all along.

Two other reasons to connect with his parents right now: 1) Objectively, what you've been doing up to this point (keeping his illness secret; educating yourself about his condition; acting as a trusted friend and confidante) has not helped. Tho you have done your very best; tho you have exhibited the strongest possible commitment to and love for him, he continues to suffer with paranoia, isolation, loss of interest in activities, diminishing emotional response, etc. Therefore, I believe you owe it to him, to yourself, and to his loved ones to let them know what's going on. They may not be able to help him either; he may reject their love and support; he may be able to hide his condition, tho I seriously doubt that he could hide it successfuly if examined by a specialist in this area, and probably couldn't hide it very long from his family, either, based on your description of his mental and emotional state. Also, he may withdraw from you, and see you as a traitor. None of this is within your control. The only things you can control - the only two decisions you must make - are whether to tell his parents about his condition, and

2) when to tell them. Tell them now. If you are going to tell them at all, neither you, nor S, nor his loved ones gain by delay on your part. In fact (this is a horrible prospect), it is impossible to predict what he may do in the future - what he may feel forced to do to protect himself from the "dangerous enemies" surrounding him. You absolutely do not want to be in the position of having him harm himself and/or others, and wondering for the rest of your life whether, had you acted differently or more quickly, a tragic outcome could have been averted.

The best of luck to you in this terrible situation. I am sending you all good thoughts, as I am sure everyone is. If you have the opportunity, and it is appropriate, I would very much like updates on S's progress.posted by cookiesncream at 9:31 AM on March 11, 2010 [1 favorite]

I really don't mean to play devil's advocate here (it's too delicate a situation for that), and other people in this thread are without a doubt experienced and wise about this subject. However, I think it's crucial to take into consideration how often you've experienced the odd behavior. I see two examples here that you've brought up, 1) the paranoid behavior during the night when you discussed music, and 2) the discussion about connections/significance with audio hallucinations. Both of these things can be caused by drug use, and I've seen this behavior first-hand in a few friends on mind-altering substances. Social withdrawal and neglecting work can also be symptoms of drug use. Could it be he was on a hallucinogen of some sort during one or both of these periods, but didn't tell you (maybe because he knew you were concerned about his drug use)? Excessive drug use is a heavy problem in itself, but is one drastically different from mental illness such as schizophrenia.

You're in a good position to make a judgment and take action to help your friend - just be careful and consider all the factors.posted by naju at 12:41 PM on March 11, 2010

Thanks for the wonderful responses everyone. I am going to visit S with a couple close friends who are also concerned about him later on this afternoon. While I'm there, I'm going to stop by (without S's knowledge of course) his university's student health services to query about what resources/steps they have available.

I am also going to print off a lot of the online resources you guys have shared to show S's parents - because I do think half of their obliviousness probably comes from their lack of knowledge about mental illness (they're from a completely different culture and this may play into that). I plan on giving them the info this weekend, as his parents live halfway between where I live/go to school and where S lives, so I can stop by their place on the way back from visiting him. This way I'll also have an updated handle on his situation, and if necessary, a couple extra people's testimony to back up my own observations.

And in response to naju and selfmedicating, while it's definitely possible that his symptoms are being caused, or at least being made worse, by his drug use, I doubt that drug-induced psychosis is the whole story. While naju is right that people on hallucinogenic drugs often behave in a similar way, S's symptoms have been going on for such a prolonged period, and he has been acting in such a consistent way, that I can't imagine drugs being the real cause.

For instance, while the examples I cited in my original question are two discrete, isolated incidents, the behavior he exhibited in them has continued in every interaction I've had with him for months. While sometimes he's not as extremely off as those cases, he has continually behaved in a similar way - e.g. a bunch of people hanging out on a front porch, smoking cigarettes, and S. will take a comment about someone's new car as a secret accusation that he is gay. This sort of thing happens nearly every time I see him, regardless of the location or people we're around. While the seeing secret signs/connections and hearing voices he couldn't possibly hear is a new development, and I haven't heard anything new about it since then, his poverty of speech, flat affect, and inability to follow a conversation or comment appropriately are a complete constant in his interactions with others.

And even more specifically, while it is possible he's been eating acid or doing MDMA or w/e secretly, his behavior doesn't seem to reflect this. I've been around people on hallucinogens (including him) before, and he doesn't seem to be tripping or high on anything most of the time, as a lot of the things we do would be extremely difficult to do while tripping, and normally I hang out with him for days at a time so I'd probably be able to perceive the up-down swing of any drug's effects.

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